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FCCN LEVEL 1 EXAM EXAMS QUESTIONS
AND ANSWERS.
minimum urine output for adult - correct answer- 0.5mL/kg/hr ADH (antidiuretic hormone) - correct answer- - water retainer
- vasoconstrictor (also called Vasopressin)
- produced by hypothalamus
- store and released from posterior pituitary ADH pathway - correct answer- - hypothalamus senses low blood volumed and increased serum osmolality
- signal pituitary to release ADH
- ADH causes kidney to retain water
- water retention increases blood volume and decreases serum osmolality ANP (atrial natriuretic peptide) - correct answer- - cardiac hormone stored in atria
- released when atrial pressure increases *works opposite of RAAS by decreasing BP and reducing intravascular volume
- important diagnostic marker in CHF hydrostatic pressure - correct answer- - forces fluids and solutes through the capillary wall and into the tissue spaces colloid osmotic pressure - correct answer- - pulling force of albumin in the intravascular spaces
- pull fluid into vasculature maintenance fluid therapy - correct answer- - replaces normal ongoing losses of water and electrolytes (urine, sweat, respiration, stool) replacement therapy - correct answer- - corrects any existing water and or electrolyte deficits
colloids - correct answer- - pull fluid into bloodstream Albumin
- 5% is osmotically equal to plasma
- 25% draws 4 times the normal volume into the circulation blood - correct answer- - not a risk free fluid replacement
- this is liquid transplant third spacing - correct answer- - fluid is not lost from the body but the fluid is not available for use in the intracellular or extracellular compartments (fluid is in between tissues/cells)
- this patient is intravascularly dry and still needs more fluid
can you give platelets through the ranger - correct answer- - no it will aggreggate the platelets hyponatremia - correct answer- - less than 135 -
- weakness
- abdominal cramping/leg cramps
- dizzy
- change in LOC
- seizures different ways to treat hyponatremia - correct answer- - hypovolemic (give IV fluid)
- euvolemic (fluid restriction)
- hypervolemic (diuretic) severe hyponatremia - correct answer- - EMERGENCY
- below 115
- give hypertonic saline if patient is symptomatic
- in ICU setting infused slowly in small amounts....be prepared to handle seizures
hypocalcemia - correct answer- 8.5 - 10.
- tetany
- muscle cramps
- trousseau's and chvosteks sign
- colicky abdominal pain treating hypocalcemia - correct answer- - IV calcium gluconate or calcium chloride (CENTRAL LINE)
- consider seizure precautions
- replace Mg in addition to Ca because pt might not respond to Ca treatment hypercalcemia - correct answer- caused by
- cancers and hyperparathyroidism
- excessive Ca and Vit. D supplements
- muscle weakness
- depressed CNS (confusion)
- dysrhythmias (prolong QT, AV block)
- abdominal pain
treating hypercalcemia - correct answer- - administer IV NS to promote diuresis
- administer loop diuretics
- corticosteroids to decrease absorption from GI
- phosphates to decrease breakdown of bones by inhibiting release
- dialysis hypomagnesemia - correct answer- - tetany
- weakness
- confusion
- ECG changes (wide QRS, prolong PR/QT) treating hypomagnesemia - correct answer- - CPR
- magnesium
- shock hypomagnesemia and digoxin - correct answer- - low MG increases pharmacologic action of digoxin
- look for N/V, bradycardia, AV block, yellow tinged vision
hyperphosphatemia - correct answer- - this is rare except for people with severe kidney dysfunction
- stroke
- heart attack
- poor circulation
- calcium combines with phosphate to form crystals that calcify on walls of vessels and heart
- crystals can form on skin too causing severe itching order for electrolyte replacement therapy - correct answer- 1. Mg
- K
- phosphorus
- Ca physical assessment of perfusion - correct answer- - pulses
- blood pressure
- skin
- kidneys
- sensorium
oxygenation - correct answer- - SPO
- nasal cannula and oxygen mask help oxygenate ventilation - correct answer- - how fast and deep pt is breathing
- look at CO2 on ABG to assess ventilation
- BiPAP, Ambu bagsm and ventilators help ventilate *patient can have good oxygenation but not be ventilating adequately systolic Blood Pressure - correct answer- - pressure on arterial walls during ventricular contraction
- increase in CO/force of contraction with exercise will increase SBP but not necessarily affect DBP diastolic BP - correct answer- - pressure during ventricular relaxation
- vasomotor tone of arterioles and venules dilated arteries = decrease DBP constricted arteries = Increase DBP
- edema is not a part of intravascular volume
- you can have a lot of edema and be dehydrated at the same time how constriction/dilation affected preload - correct answer- dilation = less preload (more dry) constriction = more preload (more wet) optimizing perfusion - preload - correct answer- low preload = give fluid (blood, fluids, colloids) high preload = give diuretics/vasodilators/dialysis your patient is experiencing angina, the provider orders nitroglycerin. what do you anticipate will happen a. blood pressure will drecrease b. preload will increase c. preload will decrease d. A and C - correct answer- D
optimizing perfusion - afterload - correct answer- - since the heart ejects into the arteries....the arteries affect the afterload
- constricted = more resistance and decreased CO
- dilated = less resistance and increased CO high afterload - correct answer- - constricted arteries
- physical assessment (cool extremities, pale, mottled
- treat = dilate arteries (ACE inhibitors, ARBs, morphine, rewarm patient) SOO how to optimize perfusion - correct answer- 1. consider fluid status
- consider how clamped down the patient is
- consider squeeze of the heart low afterload - correct answer- - low resistance = dilated arteries
- caused by sepsis, neurogenic shock
what is blood pressure - correct answer- - MAP = CO x SVR
- increase in CO or SVR will increase MAP and vice versa
- patient with MAP of 60 can have high or low CO and high or low SVR a good BP does not mean good perfusion V1 and V2 look at what part of the heart - correct answer- - septum V3 and V4 look at what part of the heart - correct answer- - anterior V5 and V6 look at what part of the heart - correct answer- - lateral lead selection - correct answer- - lead III is used to monitor patient who has no cardiac history
- lead II to look at P waves
precordial leads used - correct answer- - V3 to monitor patient who has no cardiac history
- V1 to monitor dysrhythmias and differentiate from ventricular beats
- V1 to V6 if patient has injury or infarction....chooose lead that has the most ST elevation for a normal ECG what leads do we pick - correct answer- - Lead III and V for ECG with dysrhythmia what leads do we pick - correct answer- - lead III and V ECG admission with AFIB with RVR what V lead do we choose
- correct answer- - V 1 dysrhythmias that are too fast - affects - correct answer- - heart cant fill completely
- decreases preload
- lead to decreased CO and low BP
unstable angina - correct answer- - occurs with plaque rupture
- troponin normal NSTEMI - correct answer- - non full thickness infarction of myocardium
- slight increase in troponins STEMI - correct answer- - full thickness infarction of myocardium
- increase in troponins Ischemia ECG - correct answer- - flipped T wave
- ST depression injury ECG - correct answer- - ST elevation infarction ECG - correct answer- - Q waves form after 24 hrs of infarction
ST depression - correct answer- - ISCHEMIA ST elevation - correct answer- - INJURY what to do in torsades - correct answer- - give Mg Sulfate
- CPR
- defibrillate what drugs lengthen QTc - correct answer- - antiarrhythmics
- antipsychotics
- antidepressants where do we monitor bundle branch blocks - correct answer- - V what does a LBBB look like - correct answer- - inverted and wide QRS and elevated T or opposite
- usually means MI
